Visual Outcomes of SmartSight (SCHWIND ATOS) Refractive Surgery in the Correction of Myopia and Myopic Astigmatism: A Systematic Review.

PURPOSE: To systematically review visual outcomes, refractive predictability, astigmatic correction, and safety of SmartSight refractive surgery (SCHWIND eye-tech-solutions GmbH) for the correction of myopia and myopic astigmatism.

METHODS

A systematic search of six databases was conducted for studies published from 2020 onward. Peer-reviewed clinical studies reporting visual or refractive outcomes following SmartSight refractive surgery using the SCHWIND ATOS platform (SCHWIND eye-tech-solutions GmbH) were included. Study selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Risk of bias was assessed using the Joanna Briggs Institute checklist for case series. Due to heterogeneity in study design and outcome reporting, a narrative synthesis was performed.

RESULTS

Six studies comprising 877 eyes were included, all observational case series. Postoperative uncorrected distance visual acuity (UDVA) outcomes were favorable, with 59% to 98% of eyes achieving UDVA of 20/20 or better than preoperative corrected distance visual acuity. Refractive predictability ranging from 40% (postoperative day 1) to 98% (3 months) of eyes within ±0.50 diopters (D) and 89% to 100% within ±1.00 D of the intended spherical equivalent correction. Astigmatic correction was favorable, with ⩾96% of eyes achieving residual postoperative cylinder ⩽1.00 D from pre-operative mean cylinder ranging from 0.46 to 1.30 D across studies. Loss of two or more lines of corrected distance visual acuity was uncommon, and reported complications were predominantly mild and transient, occurring both intraoperatively (opaque bubble layer, suction loss) and postoperatively (epithelial defects, incision-related issues).

CONCLUSIONS

SmartSight refractive surgery demonstrates favorable visual and refractive outcomes with an acceptable safety profile. However, current evidence remains early, derived mainly from case series with limited follow-up, potential conflicts of interest, and no randomized controlled trials. Further prospective and comparative studies are required to confirm long-term outcomes.